1. Staff: Janet Sharkis, Patricia Bailey, June Villarreal
The Prenatal Promise: The Challenges and Hope of an Alcohol Free Pregnancy
By the: Texas
Office for
Prevention of
Developmental
Disabilities
Staff: Janet Sharkis, Patricia Bailey, June Villarreal
Today, I hope to give you some ideas for how to talk about alcohol, about fasd and overall health with your clients. I am going to give you a range of strategies. I am a firm believer in finding what works best for you, so I am giving you a lot to choose from so you can choose what is best for you. I find that I sometimes go to conferences, get a lot of good information but may struggle with how to use it when the client is in front of me. I am hoping to give you some actual techniques. You can use what you need and lose the rest.

2. True or false –fun quiz!
Alcohol exposure can be more damaging to a baby than drug exposure.
With the right support, children with FASD catch up to their peers.
Prenatal alcohol exposure is the leading cause of mental retardation in the United States.
FASD is as prevalent as Autism Spectrum Disorder.
FASD was identified 30 years ago.
FASD is more common among wealthier families.
Children with physical signs of FASD, such as their facial appearance, demonstrate the most behavioral issues.
Fewer than 10% of the people born with an FASD can live independently.
Most children with an FASD have an IQ within the normal range.
Children with an FASD are often misdiagnosed with Oppositional Defiant Disorder (ODD).
Alcohol passed through breastfeeding is not dangerous to the baby.
Approximately 1 out of 100 children have an FASD.
What surprised you? What do you think would surprise the women you work with? Although knowledge is power, knowledge alone doesn’t change behavior. Knowledge and purpose are more powerful and knowledge, motivation and purpose creates change. Changing behaviors takes much more than knowledge.

3. Some more data (just felt like I needed to give you more stats, sorry )
There is a lot of drinking going on among women
of childbearing age* in Texas!
10.9% binge drink (more than 7 drinks on any occasion)
3.9% chronically drink
At risk for binge/heavy drinking:
large metro areas: 19.8 %
Rural areas: 6.2%
Some of them may be pregnant and don’t know it.
* Childbearing age defined as years.

4. We know that lots of pregnant women in TX are drinking
One month before delivery,
pregnant women admitted:
9.3% alcohol use
2.2% binge alcohol use
1.1% admitted heavy use
In TX the number one reason women are admitted to treatment… Alcohol!

5. Another factor…unplanned pregnancies
Although specific data on unplanned
pregnancies is hard to come by, we can draw some conclusions:
Texas has the 5th highest teen pregnancy rate in the country. (mostly unplanned)
70% of the pregnancies of college students in Texas are unplanned.
Texas ranks 38th in the nation on prenatal care (may partially be because so many don’t know they are pregnant.)
If many women didn’t plan to be pregnant and didn’t know
They were pregnant, they wouldn’t have felt the need to
take any special precautions related to their health or
diet.
There is no reason to believe that they aren’t drinking as
usual.

6. A perfect storm in Texas
Social messages and norms:

7. Option 1: The Conversation
I often start these conversations with
An affirmation about the client and then:
An “I was surprised to learn” statement.
With the affirmation statement, I try to find something specific about the client… or about the hopes and dreams the individual has about her family and her life.
Then the “I was surprised to learn” statement is a
way of leveling the playing field with the client and
sharing a piece of information about alcohol and
child development.
Beginnning the conversation about alcohol is often the biggest hurdle.

8. Practice Break up into small groups and just work
on the first 2 pieces, an affirmation and
the bridge statement, which for me is the
surprise statement.
If you have other ways of beginning the
Conversation, you can use them and
share!

9. Option 2: The 4 Ps: Parents, Partners, Past and Present Developed by Dr. Ira Chasnoff
Did either of your parents have any problems with alcohol or drugs?
Does your partner have any problems with drugs or alcohol?
Have you ever drunk beer, wine, liquor? (past)
In the month before you knew you were pregnant, did you smoke cigarettes? (present)
In the month before you had any idea you were pregnant, did you drink? (pregnancy)
This is another way to begin the conversation. The idea here is to start with others. Often women are more comfortable when they are first asked about others. In addition to drinking, you can use this to talk about other health factors, such a reproductive health, healthy eating habits, etc. This also helps to bring home the fact that others are a part of the health picture of a woman. You can learn a lot about a woman by discussing others who are significant in her life. You might be able to identify people who can help her within her support system as well. A “yes to any one of these questions signals a need for a referral. When this screening was used at several sites across the country, 20% admitted alcohol use and about half of those women continued to drink once they were aware of their pregnancy. Of those who continued to drink, 9% wre heavy drinkers, 7% drank 3-6 days per week and 2% drank daily. 27% drank one or 2 days per week. Recent studies demonstrate substantial risk for their child. These are the women who are most likely missed through a typical screening.

10. Option 3: Comparison of Drinking
High risk=
More than 7 drinks per week or more than 3 drinks in a day.
Low risk=
No more than 7 drinks per week and no more than 3 drinks in a day.
Here is another approach: Sometimes it helps for women to take a look at their alcohol use and then compare it to the general population. Often they are surprised when their use is higher than average. You may also want to note that some women only view ‘hard liquor” as a drink and alcohol may not report a margarita as a drink. You may want to ask them about the good things and not so good things about drinking, to help them weigh their decisions. You may also want to do that regarding birth control-what’s good about taking it and not good.
Drinking Comparison
Note that this chart is for the general population, not pregnant women.

11. health of your child Discussion: Not Important Very Important
Here is a 3rd choice, using these scales with women can be anotehr way of creating the conversation. Most women will state that the health of their child is important to them and mean it. The challenge comes in on acting on one’s values. As WIC providers, you are all very conscious of health, but I am willing to bet that someone ate something unhealthy today. Every day we make decisions that don’t reflect our values. It is important to remember that when providing these messages.

12. Your health in relation to your child, baby, unborn child…
More discussion
Your health in relation to your child, baby, unborn child…
Not Important
Often women feel a disconnect between their health and the health of their children. Intelellectually, we know about the connection, but we may not feel the connection. In fact, we may feel the opposite, that if we take care of ourselves, we aren’t caring for our children. We can make this real to women by talking with them about what they grew up with. Another way of looking at this…Most mothers will can give an example of something their child learned by watching somebody else that they wished the child hadn’t learned. Children pick up their healthy habits and lifestyles from their parents.
Very important

13. Taking care of my health Not taking care of my health
How its going…
Taking care of my health
Not taking care of my health
Define together all of what taking care of health means: mental health, positive relationships, eating, sleeping habits, reproductive health, substance use-alcohol, tobacco, other drugs, exercise.
You can help them identify where they feel they are doing best and what they need to work on. I call this the, “what to build on and what to work on” scale. What they are doing well is the platform for what they can do well. So if they feel they have good eating habits, well, how did they develop them. Maybe they had a good, role model, maybe they have fun with it, What helped them in one area that can help them in a challenge area? What’s in it for them to keep unhealthy habits? You can talk about how it is sometimes easier to care for others than to care for themselves. Self care is something that a lot of women don’t think about.

14. The Peacock Challenge: Taking stock
I take pride that I am doing ___ for my health.
I take pride in avoiding these things _____ that can hurt my health.
I can make my health and my baby healthier by _________________.
I call this my “peacock” challenge because the goal is to help the person feel proud as a peacock. We all might want to be as proud as a peacock. What’s taking away from our sense of pride in ourselves? Sometimes a visual image of a goal can be helpful. You can look at the areas you are working on as feathers you want to add.

15. Are you ready? To improve your health (and the health of your baby) ?
You can use the same scale to gear confidence-how confident are you that you can improve your health? Then you can identify health hurdles.
I am working on it.
Not now
I am committed to it.
Okay, I am thinking about it
I am planning on it.

16. The look and feel of FASD behavior
What you see
Throws fits
Breaks rules
Learning problems
Doesn’t sit still
Lying
Why its happening
Constantly frustrated
Can’t remember rules, can’t generalize from one situation to another, can’t understand underlying concept
Unable to interpret instructions, retain information, understand cause and effect, deal with abstract concepts.
Experiencing sensory overload, neurologically based need to move while learning.
Doesn’t recall, can’t sequence, trying to figure out what others want to hear.
What do you think FASD looks like for an adult?

17. What they need Consistent environment-minor changes can impact child.
Repetition
Visual, kinesthetic, along with verbal
Rephrasing
Rhyming
Small chunks of information

18. Drinking before Birth: The Truth and the Consequence
On Line training April 29th
Drinking before Birth: The Truth and the Consequence
By Janet Sharkis and Natalie Furdek, Lead Program Specialist Women's Substance Abuse Services Coordinator
This training will focus more on the specifics around FASD and the brain and include more specific information about referral resources.

19. Resources www.topdd.state.tx.us www.thearcoftexas.org
If you or someone you know would like information
about substance abuse treatment or prevention,
please visit: